January 2011

Medicare Set Asides (MSAs) – Liability and Workers Compensation

Did you know, the Social Security Law establishes Medicare as a Secondary Payer for Liability (including self insured), No Fault or Workers Compensation insurance claims involving Medicare and Medicaid beneficiaries? The obligation with regard to protecting Medicare's interest is exactly the same for Workers Compensation and Liability claim situations. So where future medicals are a consideration in a claim prior to settlement, then appropriate arrangements including a Medicare Set Aside with Centers for Medicare and Medicaid Services (CMS) approval is highly recommended before Medicare is billed for related services. Making the most prudent decision, can make a difference to avoid potential fines, interest, and or penalties.

How does the New Conditional Payment Notice (CPN) Process Work?

A CPN is issued in lieu of a Conditional Payment Letter (CPL). In certain instances when a settlement, judgment, award or other payment has already occurred. The CPN provides conditional payment information and tells you exactly what actions must be taken with the Medicare Secondary Payer Recovery Contractor (MSPRC). There are two instances when this letter will be issued in place of the usual CPL. They are: If the MSPRC is notified of a settlement, judgment, award, or other payment through Section 111 reporting rather than from the beneficiary or their representative. If the MSPRC has been alerted to a settlement, judgment, award, or other payment by the beneficiary or their representative before the usual Conditional Payment Letter (CPL) has been issued.

MMSEA Section 111 Data Reporting Are You Ready?

With the Medicare Secondary Payer Mandatory Reporting now underway including liability (self insurance), no-fault insurance, and all workers' compensation, it is good to ensure you have a compliance strategy in place to avoid any possible fines & or penalties. If you still have not yet selected a data reporting vendor and are not fully ready with your reporting, then please give us a call today along with reviewing the latest MMSEA Section 111 Mandatory Insurer Reporting Alerts at: